Torsion of the spermatic cord is a true surgical emergency of the highest order.
Sudden onset orchialgia (pain in scrotum) in a young male should be considered seriously as it could lead to catastrophic consequences resulting from a twist of the testes within its coverings that could lead to complete loss of blood supply causing necrosis, and thus, complete destruction of the testes.
A situation of this kind can be prevented by timely referral of this emergency in the golden hour in a young child to adolescent male to a middle aged person who presents with a sudden onset pain testes, nausea, vomiting, minimal or no urinary complaints and is accompanied with progressive swelling and discolouration of the scrotum.
An 18 years old male presented with progressive pain in left testes for two days. He was on medical treatment for the same during that period. Examination revealed a hard, discoloured hemi scrotum, with minimal sensations, absence of blood supply on urgent Doppler ultrasound of the scrotum before he was taken for emergency scrotal exploration. On table it was found to have left infarcted and necrosed testes beyond recovery. Left orchidectomy was done along with right orchidopexy to prevent a similar future phenomenon on the anatomically predisposed testes.
Torsion of the spermatic cord, should not be confused with Epididymitis that is more common in a sexually active age group with urinary complaints, gradually setting in with fever and swelling, as compared to children who do suffer with this phenomenon during straining and activity of extreme muscular kind, helps in early referral and manual detorsion before swelling sets in or an operative detorsion. This saves the testes and thus all future worries related to fertility and loss of self esteem that accompanies orchidectomy in younger age group. An artificial testes can be implanted to keep the patient aloof of the past emergency and trauma. The new testes can be implanted after recovery via inguinal route.
Torsion of the spermatic cord is an emergency that can be averted by timely referral and evaluation by your Urologist.